Capitation or HMO Dental Plans

Capitation plans are another form of managed care. They are also called a Dental Health Maintenance Organization or HMO. Participating dentists are paid a set amount for each person enrolled in the plan, rather than for actual treatment provided and whether they visit the dentist or not. Unfortunately, this type of plan encourages a “significant delay” in treatment, minimal services and the use of lower quality material. In other words, the provider looses money every time you require treatment or need to be seen, although a small co-payment is due at each visit.

The best financial situation for participating providers is to delay care or limit treatment options to the least expensive option regardless of desires you may have for higher quality care. And you can only see participating dentists and specialist, regardless of the quality of care you feel you are receiving. If you decide to see a dentist which is not on the HMO list of providers, charges for service will not be covered by the plan. Only about 73% of the monies spent on a HMO program goes to actual patient care. The remaining 27% goes to the insurance company.